RUSSELL MARTIN CARLSON DPM Podiatrist License verification

Business Entity

EXPIRED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135000650

License Status

EXPIRED

Business

Title

DPM

First Name

RUSSELL

Middle

MARTIN

Last Name

CARLSON

Business Name

RUSSELL MARTIN CARLSON DPM

Original Issue Date

06/27/2008

Effective Date

07/01/2009

Expiration Date

06/30/2010

City

DAVENPORT

State

Zip

52807

Ever Disciplined

LastModifiedDate

07/08/2010